Provider Demographics
NPI:1447357538
Name:SMITH, SUSAN G (RPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JOLLEY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3062
Mailing Address - Country:US
Mailing Address - Phone:860-243-3434
Mailing Address - Fax:860-243-0208
Practice Address - Street 1:35 JOLLEY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3062
Practice Address - Country:US
Practice Address - Phone:860-243-3434
Practice Address - Fax:860-243-0208
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT004312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist